Pertussis in infants: an underestimated disease

Vittucci, Anna Chiara; Spuri Vennarucci, Valentina; Grandin, Annalisa; Russo, Cristina; Lancella, Laura; Tozzi, Albero Eugenio; Bartuli, Andrea; Villani, Alberto

The clinical suspicion of pertussis is not easy in infants. Among the 53 patients BP+, pertussis was suspected only in 16 patients (30.2 %) at the admission. Clinical suspicion has a low sensitivity in this age group. In absence of a systematic use of laboratory tests for the diagnosis of pertussis in infants with respiratory symptoms, many infants with BP infection may go unrecognized [17] . In a hospital environment, the lack of recognition of such an infection may represent a severe risk for hospital outbreaks, since pertussis may be transmitted to contacts if appropriate antibiotic therapy is not applied. As a matter of fact we did not observe any hospital secondary pertussis case over the study period. Our data suggest that, despite routine surveillance shows a low incidence of pertussis in Italy, BP infection is still circulating in unvaccinated infants and nearly 25 % of patients younger than 3 months of age hospitalized with respiratory symptoms resulted positive for BP in our case series, according to what previously reported [18] . Clinical manifestations of pertussis can overlap with those of other diseases and can be atypical. Nonetheless our data, in line with the literature [19] [20] [21] , suggest that some feature should alert clinicians to suspect pertussis: the hallmark clinical characteristic is paroxysmal cough; fever is usually absent and laboratory findings showed marked lymphocytosis. On the other hand the absence of typical symptoms does not exclude the diagnosis of pertussis.